New PE-RADS framework aims to bring clarity to pulmonary embolism imaging

Clinical takeaway: When reviewing CT or MR angiography for suspected acute pulmonary embolism, use PE-RADS alongside the full radiology report and clinical risk assessment—not as a stand-alone treatment algorithm.

Standardized CT and MR angiography reports may reduce communication gaps among radiologists, emergency clinicians, cardiologists, pulmonologists, and interventional teams managing acute pulmonary embolism (PE).

A multidisciplinary expert panel has introduced PE-RADS v2026, the first standardized lexicon and structured imaging-reporting framework for acute pulmonary embolism. The consensus system was developed through the American College of Radiology with representatives from six other emergency medicine, pulmonary, cardiovascular, radiology, and pulmonary embolism organizations.

PE-RADS assigns a score according to the most proximal acute clot: 0 indicates no embolism; 1, subsegmental; 2, segmental; 3, lobar or interlobar; and 4, central involvement of the main, right, or left pulmonary artery. A nondiagnostic examination is labeled N, while 0L indicates that no central embolism was found but segmental or subsegmental assessment was limited.

Reports can also include RV+ when the right-to-left ventricular ratio is at least 1.0 and T+ when definite thrombus is seen in the right atrium or ventricle. Right-heart thrombus has been reported in approximately 2.0% to 4.9% of patients with acute PE and may prompt urgent specialty evaluation. An E modifier identifies filling defects from other causes, including chronic thromboembolism, tumor, foreign material, or in situ thrombus.

Higher categories, particularly PE-RADS 3 or 4 with RV enlargement, signal the need for clinical risk stratification and consideration of cardiovascular assessment, PE specialist consultation, or reperfusion therapy. Imaging findings alone do not dictate treatment.

“Standard terminology reduces variability in reporting and understanding the radiology report,” said committee chair Lynne M. Koweek, MD. The framework has not yet been prospectively shown to improve outcomes; future studies will evaluate its effects on treatment timing, resource use, and patient outcomes.

The authors emphasize that PE-RADS complements, rather than replaces, clinical assessment and existing PE management guidelines. They anticipate that standardized reporting will improve communication among care teams, facilitate appropriate triage and treatment decisions, and create a stronger foundation for future research on outcomes and resource utilization.

Source: Koweek LM, et al. (2026 July 21) Radiology. Pulmonary Embolism Reporting and Data System (PE-RADS™) v2026 for the Diagnosis of Acute Pulmonary Embolism on CT and MR Angiography